Provider Demographics
NPI:1659385359
Name:PETERSILGE, WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:PETERSILGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:216-844-5595
Mailing Address - Fax:216-844-5522
Practice Address - Street 1:1000 AUBURN DR # 210
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4317
Practice Address - Country:US
Practice Address - Phone:216-844-5595
Practice Address - Fax:216-844-5522
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHBP1984740207XS0114X
OH35-057863207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH738084OtherBUCKEYE
OH000000221152OtherUNISON
OH0929106Medicaid
OHP00076234OtherRAILROAD MEDICARE
OHP00358835OtherRAILROAD MEDICARE
OH0655674OtherAETNA
OH000000503689OtherANTHEM
OH363909OtherWELLCARE
OH738084OtherBUCKEYE
OH363909OtherWELLCARE
OH0929106Medicaid